Popma J J, Ellis S G
Department of Internal Medicine (Cardiology Division), University of Michigan Medical Center, Ann Arbor.
Herz. 1990 Oct;15(5):307-18.
Limitations of current forms of coronary angioplasty including abrupt vessel closure and delayed restenosis have led to the development of alternative nonsurgical methods of coronary revascularization. By scaffolding the arterial dissection and smoothing the endoluminal surface, intracoronary stenting may obviate the need for emergency coronary bypass surgery in patients who develop abrupt vessel closure following coronary angioplasty. As primary therapy, its use may prevent or delay restenosis in high-risk patients; however, due to potential patient selection bias, controlled studies are needed. Currently available intracoronary stents are limited by varying degrees of inflexibility, radiolucency, and thrombogenicity. These limitations have resulted in the development of innovative stent designs using radioopaque tantalum filaments and aggressive pharmacologic treatment with antiplatelet and anti-thrombotic therapy following stent deployment. Current experimental investigation into the feasibility of intracoronary stent coating with genetically engineered endothelial cells or slow release antiproliferative agents, such as colchicine or methotrexate, may further serve to lessen the frequency of late restenosis. The optimal patient selection criteria for the use of the intracoronary stent is currently the subject of intense clinical investigation.
当前冠状动脉血管成形术存在包括血管突然闭塞和延迟性再狭窄等局限性，这促使了替代性非手术冠状动脉血运重建方法的发展。通过支撑动脉夹层并使管腔内表面光滑，冠状动脉内支架置入术可能避免在冠状动脉血管成形术后发生血管突然闭塞的患者中进行急诊冠状动脉搭桥手术。作为主要治疗方法，其应用可能预防或延迟高危患者的再狭窄；然而，由于潜在的患者选择偏倚，需要进行对照研究。目前可用的冠状动脉内支架受到不同程度的柔韧性不足、射线不透过性和血栓形成性的限制。这些局限性促使了采用不透射线的钽丝的创新性支架设计的发展，以及在支架置入后采用抗血小板和抗血栓形成的积极药物治疗。目前对用基因工程改造的内皮细胞或缓释抗增殖剂（如秋水仙碱或甲氨蝶呤）进行冠状动脉内支架涂层可行性的实验研究，可能进一步有助于减少晚期再狭窄的发生率。使用冠状动脉内支架的最佳患者选择标准目前是深入临床研究的主题。
